Choriocarcinoma arising at an abdominal wall cesarean scar is not only exceedingly rare and diagnostically challenging but also represents a therapeutic dilemma, particularly when it becomes chemoresistant or relapses after multi-line chemotherapy. Here, we report a 40-year-old woman initially managed for suspected ectopic pregnancy with two dilation and curettage (D&C) procedures and three doses of methotrexate (MTX) therapy, but her serum β-hCG level remained persistently elevated. Further imaging examinations revealed concurrent lesions in the uterine cavity and abdominal wall cesarean scar, and subsequent surgical excision confirmed a high-risk choriocarcinoma at the scar, corresponding to a prognostic score of 10. Postoperative EMA/CO chemotherapy transiently normalized serum β-hCG levels, followed by the first recurrence. Subsequent salvage therapies (EMA/EP, re-resection, and FAV regimen) yielded only short-lived remissions, with β-hCG rebounding above 1000 mIU/mL, indicating second recurrence. Moreover, the suboptimal decline in β-hCG in response to TP/TE and FAEV regimens after the second recurrence further demonstrated the limited efficacy of chemotherapy. In addition, immunohistochemical profiling showed CD8+T cell infiltration, PD-L1 expression with a tumor proportion score of 40%, and VEGF/EGFR positivity, along with intact mismatch repair proteins. Collectively, these findings provide a rationale for the use of immune checkpoint inhibitors (ICIs), which have shown superior complete response rates in chemorefractory gestational trophoblastic neoplasia (GTN) compared with standard or high-dose chemotherapy. Notably, both the 2025 EOTTDESGOGCIGISSTD and FIGO guidelines recommend immunotherapy before high-dose chemotherapy for recurrent disease, suggesting that a personalized combination of ICIs with chemotherapy and/or anti-angiogenic agents may represent a promising salvage strategy. This case underscores the diagnostic challenge, limited durability of multi-line chemotherapy and surgery, and emerging role of immunotherapy. Early recognition, pathological confirmation, standardized chemotherapy, timely surgery, and appropriate introduction of ICIs remain key to improving outcomes in this rare entity.

Immune-mediated necrotizing myopathy (IMNM) is a rare and heterogeneous subgroup of idiopathic inflammatory myopathies. IMNM is broadly classified into seropositive disease, encompassing anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) and anti-signal recognition particle (anti-SRP) antibody-associated forms, and seronegative IMNM. Although seronegative IMNM has traditionally been considered largely analogous to seropositive disease, emerging evidence suggests that it may represent, at least in part, a distinct clinical entity. This review synthesizes the current evidence regarding the clinical management of seronegative IMNM.

Gestational choriocarcinoma with inferior vena cava (IVC) tumor thrombus formation is exceedingly rare. We report a case initially presenting with recurrent nausea and vomiting in a 52-year-old woman. Laboratory studies revealed elevated serum β-hCG levels, and ultrasonography demonstrated a pelvic mass extending from the parametrial area into the IVC. Pathological examination of a pelvic mass biopsy confirmed the diagnosis of choriocarcinoma. Further assessment identified pulmonary hypertension and emboli within small pulmonary artery branches. The patient received EMA-CO chemotherapy and achieved complete remission, with no evidence of recurrence during a one-year follow-up. This case highlights the diagnostic challenges posed by non-classical metastases and underscores the importance of considering choriocarcinoma in the differential diagnosis of women with a pregnancy history and unexplained systemic symptoms.

Francisella tularensis can cause a broad spectrum of clinical manifestations depending on the route of inoculation. In northeastern France, tick bites are a frequent route of transmission. Typically, vector-borne inoculation results in glandular or ulceroglandular forms, whereas aerosol exposure causes pulmonary forms. We report the case of a 72-year-old immunocompromised woman (rheumatoid arthritis treated with methotrexate) who developed pneumonia six days after a tick bite, diagnosed four weeks later with a glandular tularemia. Although Francisella tularensis was not isolated from the lungs, a diagnosis of pulmonary tularemia was suspected at the adenitis stage based on serology and Polymerase chain reaction testing performed on the affected lymph node. The patient was successfully treated by ciprofloxacin. This case underscores the possibility of pulmonary tularemia following tick bites and the fact that multiple clinical forms may coexist in the same patient. Physicians should consider tularemia in case of pneumonia, especially when suggestive factors such as tick exposure or adenitis are present.

Neoadjuvant therapy is now a cornerstone of muscle-invasive bladder cancer management, evolving from traditional cisplatin-based chemotherapy to novel immunotherapy and antibody-drug conjugate combinations. While dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin remains the cytotoxic standard, the phase III NIAGARA and KEYNOTE 905 trials have established new benchmarks for cisplatin-eligible and ineligible populations, respectively. Furthermore, the integration of molecular subtyping, DNA damage repair biomarkers, and liquid biopsies (circulating tumor DNA) is facilitating a shift toward precision medicine. These advancements aim to optimize pathologic response, improve overall survival, and identify candidates for bladder-sparing approaches.

Primary central nervous system lymphoma (PCNSL) is an aggressive subtype of non-Hodgkin lymphoma with a poor prognosis, high rate of refractory or relapsed (R/R) disease, and no established standard of care for R/R PCNSL. This phase 2 study evaluated the efficacy and safety of tirabrutinib, a potent, highly selective, second-generation Bruton tyrosine kinase inhibitor, in patients with R/R PCNSL in the US. In the open-label PROSPECT study, adults with R/R PCNSL whose disease progressed on or after ≥1 high-dose methotrexate-based therapy received once-daily oral tirabrutinib 480 mg. The primary endpoint was overall response rate (ORR), and secondary endpoints included complete response (CR) rate, duration of response (DOR), and time to response (TTR), as assessed by independent review committee. Safety was assessed by frequency and severity of treatment-emergent adverse events (TEAEs). Among 48 enrolled patients, median follow-up was 11.5 months, ORR was 67% (95% confidence interval [CI], 52-80), and CR rate was 44% (95% CI, 29-59). Median DOR was 9.3 months (95% CI, 4.6-14.6), and median TTR was 1.0 month (range, 0.9-3.7). Treatment-related TEAEs occurred in 36 patients (75%), most commonly anemia (19%), maculopapular rash (17%), fatigue (15%), neutropenia (15%), lymphocytopenia (15%), pruritus (15%), and other rash (15%). Grade ≥3 treatment-related TEAEs occurred in 13 patients (27%), most commonly neutropenia (8%) and maculopapular rash (6%). One death (bronchopulmonary aspergillosis) was treatment related. In patients with R/R PCNSL, once-daily oral tirabrutinib monotherapy resulted in rapid and durable responses and demonstrated a favorable safety profile. This trial was registered at www.clinicaltrials.gov as NCT04947319.

Psoriasis is a persistent, immune-driven inflammatory skin disorder impacting an estimated 125 million individuals globally. The pursuit of effective and safe treatments at affordable costs remains an ongoing challenge. Phytochemicals show promise due to their anti-inflammatory and immunomodulatory effects. Phytochemicals 18β-glycyrrhetinic acid (GA) and hesperetin (HST) exhibit excellent anti-inflammatory properties in cells; however, their low oral bioavailability in the blood compromises their therapeutic potential. This study aimed to evaluate the combined effects of GA and HST in lipopolysaccharide (LPS)-stimulated RAW264.7 cells and an imiquimod (IMQ)-induced psoriasis mouse model. The results demonstrated that GA and HST synergistically inhibited nitric oxide production at a 1:1 concentration ratio in vitro. The combination also reduced IL-1β and IL-6 levels in LPS-stimulated RAW264.7 cells more effectively than either compound alone. Compared with either treatment alone, the combination of these two compounds significantly reduced the PASI scores, spleen index, Baker's histology score, and pro-inflammatory cytokines IL-1β, IL-6, IL-17, IL-22, IL-23, and TNF-α in the IMQ-induced psoriasis mouse model. Moreover, this combination also significantly upregulated the expression of the anti-inflammatory cytokine IL-10. The anti-psoriatic effects of this combination are comparable to the reference drug methotrexate. This research provides a rationale for the combination of GA and HST as an effective anti-psoriatic agent.

Liver function monitoring remains a cornerstone of safety surveillance during methotrexate (MTX) therapy for rheumatoid arthritis (RA). Traditionally, monitoring has focused on hepatitis B virus (HBV) reactivation and chronic MTX hepatotoxicity. Because HBV persists in hepatocytes as covalently closed circular DNA (cccDNA) even after apparent clinical resolution of infection, all individuals with previous HBV exposure remain at risk of viral reactivation. Accordingly, screening for previous HBV infection before initiating MTX is essential, and regular monitoring of HBV DNA should be considered in patients with resolved or chronic HBV infection. Close collaboration with hepatology specialists is required to ensure timely initiation of nucleos(t)ide analogue therapy when indicated. In contrast, the conventional concept of chronic MTX-induced hepatotoxicity has been increasingly challenged. Recent studies employing non-invasive fibrosis assessment tools have demonstrated little or no association between cumulative MTX dose or treatment duration and the progression of liver fibrosis. These findings suggest that severe chronic liver injury caused solely by MTX is uncommon and that the hepatotoxic potential of MTX may have been substantially overestimated. Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver disease worldwide and appears to be at least as prevalent among patients with RA than in the general population. Therefore, evaluation and management of MASLD should be considered as part of routine clinical care for patients with RA. Because liver fibrosis is the most important determinant of long-term hepatic outcomes, monitoring strategies should incorporate fibrosis assessment using non-invasive tools such as the fibrosis-4 (FIB-4) index and elastography-based liver stiffness measurement.

Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory dermatosis characterized by recurrent sterile pustules on the palms and soles and often shows inadequate or unsustained responses to conventional systemic therapies and biologics. We report a 58-year-old woman with a 3-year history of refractory PPP. Before referral, oral prednisone and acitretin provided only transient disease control, with rapid relapse during dose tapering. Apremilast combined with topical halometasone cream and 308-nm excimer laser therapy failed to adequately control the plantar lesions. After referral, the patient declined cyclosporine and methotrexate because of concerns regarding potential systemic adverse effects. Baseline PPPASI and DLQI scores were 46.0 and 23, respectively. Secukinumab 300 mg with topical halometasone reduced the scores to 22.0 and 18 by week 8, indicating a partial but clinically inadequate response. Clinically active plantar lesions persisted, and new intensely pruritic erythematous papules developed on the lower extremities, accompanied by peripheral eosinophilia (0.62 × 10[9]/L) and elevated serum IgE (256 kIU/L). Secukinumab and topical halometasone were discontinued at week 8, and abrocitinib was initiated at 100 mg once daily. PPPASI decreased to 1.5 and 1.2 and DLQI to 8 and 3 at weeks 4 and 8, respectively. By week 8, the lower-extremity papules had markedly improved, and the eosinophil count and serum IgE had returned to their reference ranges. At week 16, disease control remained stable without treatment-related adverse events or laboratory abnormalities. This case suggests that abrocitinib may represent a potential treatment option for selected patients with refractory PPP who exhibit a partial but clinically inadequate response to secukinumab and concurrent clinical and laboratory changes suggestive of Th2-associated inflammation.

Secondary central nervous system lymphoma (SCNSL) at initial diagnosis is an aggressive malignancy associated with a dismal prognosis. Standard-of-care treatments based on high-dose methotrexate often yield suboptimal outcomes. Although CD19-directed chimeric antigen receptor T-cell (CD19 CAR-T-cell) therapy is established in relapsed/refractory settings, its efficacy as a frontline intervention for SCNSL remains poorly defined. We report two cases of treatment-naive SCNSL that achieved sustained complete remission (CR) following a novel sequential therapeutic approach. Case 1 (65-year-old male) received Pola-ZR induction therapy (polatuzumab vedotin, zanubrutinib, and rituximab), while Case 2 (56-year-old female) received ZPR induction therapy (zanubrutinib, pomalidomide, and rituximab) followed by autologous stem cell transplantation. Both patients subsequently received CD19 CAR-T-cell infusions. Rapid CR was achieved and maintained for 24 and 21 months, respectively, with manageable toxicities. Frontline CAR-T-cell therapy combined with targeted agents may constitute a promising therapeutic paradigm for newly diagnosed SCNSL, yet these hypothesis-generating findings require validation in larger patient cohorts.